<div class="form_grid_12" style="width: 600px">
    <form action="<?php echo $this->Html->url(array('controller' => 'Pacientes', 'action' => 'ajaxantecedentesanteriores')) ?>" method="post" class="form_container" id="miForm">
        <ul>
            <li>
                <div class="form_grid">
                    <label class="field_title" for="name">Busqueda cie10</label>
                    <div class="form_input_12">

                        <?php echo $this->Form->hidden('paciente_id', array('value' => $idpaciente)); ?>
                        <?php echo $this->Form->hidden('consultasexterna_id', array('value' => $idconsulta)); ?>
                        <?php echo $this->Ajax->autoComplete('dato', '/Ciedes/ajaxautocomplete', array('extraParams' => 1)); ?>
                    </div>
                </div>
            </li>

            <li>
                <div class="form_grid">
                    <label class="field_title" for="name">Observaciones </label>
                    <div class="form_input_12">
                        <?php echo $this->Form->textarea('observaciones'); ?>
                    </div>
                </div>
            </li>
            
            <li>
                <div class="form_grid">
                    <label class="field_title" for="name">Fecha Patologia</label>
                    <div class="form_input_12">
                        <input type="date" name="data[Antecedentesginecologico][fum]" style="width: 150px;">
                    </div>
                </div>
            </li>

            <li>
                <div class="form_grid_12">
                    <div class="form_input">
                        <button type="submit" class="btn_small btn_blue"><span>Registrar CIE10</span></button>
                        <button type="reset" class="btn_small btn_blue"><span>Limpiar datos</span></button>
                    </div>
                </div>
            </li>
        </ul>
    </form>
</div>